May 17, 2024: National Advocacy Update

The House Committee on Ways and Means was the first to take substantive action in the sprint to pass legislation to extend the current telehealth flexibilities before they expire on Jan. 1, 2025. On May 8, the Committee unanimously passed H.R. 8261, the Preserving Telehealth, Hospital, and Ambulance Access Act.

Introduced by Reps. David Schweikert (R-AZ) and Mike Thompson (D-CA), the legislation continues all the key telehealth flexibilities initiated at the start of the COVID-19 pandemic that were subsequently extended through the rest of this year via the Consolidated Appropriations Act, 2023. More specifically, H.R. 8261 includes through 2026:

• An extension of the exemption to the geographic and originating site restrictions so urban, suburban and rural Medicare patients can receive telehealth services. In addition, all Medicare beneficiaries can receive telehealth services inside the home, as well as at any other site where they can access a telecommunications system, rather than being forced to travel to an acceptable brick-and-mortar health care location.
• A continued moratorium on the requirement for an in-person visit within 6 months of the beneficiary receiving the first telemental health service. Although never implemented following enactment in the Consolidated Appropriations Act, 2021, this requirement would stifle access to telemental health services.
• Authority to provide audio-only telehealth services.

Throughout the 118th Congress, AMA has consistently pressed federal lawmakers to not let these crucial extensions expire at the end of this year. In fact, AMA is a strong supporter of both H.R. 4189/S. 2016, the CONNECT for Health Act, and H.R. 7623/S. 3967, the Telehealth Modernization Act, two prominent bipartisan bills that permanently extend these three policies that are only continued for an additional two years in H.R. 8261. The CONNECT for Health Act, which is also led by Reps. Schweikert and Thompson, has 49 House and 65 Senate cosponsors, while the Telehealth Modernization has 12 and 11 cosponsors in the House and Senate, respectively. H.R. 8261 also continues the current Acute Hospital at Home Waiver flexibilities through 2029, another policy strongly supported by the AMA.

Other key congressional committees, including the House Energy and Commerce and Senate Finance Committees, are expected to introduce, mark up and pass their own pieces of legislation that will extend existing telehealth flexibilities in the short term. The AMA will continue to work with both parties and chambers to ensure these life-saving policies do not expire at the end of this year. The AMA also applauds (PDF) the House Ways and Means Committee for passing a short-term extension of the telehealth flexibilities.

On May 8, the AMA, American Academy of Neurology (AAN), and Physicians for American Healthcare Access (PAHA), jointly sponsored a congressional briefing entitled, “The Conrad 30 Program Turns 30! A Celebration of Strengthening Access to Health Care in Underserved Communities.” Held in the Capitol Visitors Center and dedicated to raising awareness on Capitol Hill about the importance of passing H.R. 4942/S. 665 (PDF), the Conrad State 30 and Physician Access Reauthorization Act, the event featured prominent bipartisan congressional speakers and a panel discussion.

Sen. Amy Klobuchar (D-MN), the lead sponsor of the Senate legislation, and Rep. David Valadao (R-CA), the co-lead sponsor of the House bill, addressed an audience of approximately 100 congressional staff and health care stakeholders. Their remarks stressed the importance of marking the 30th anniversary of the enactment of this policy that helps increase and diversify the American physician workforce. Rep. Brad Schneider (D-IL) also planned to participate but was forced to cancel at the last minute due to unanticipated responsibilities stemming from a concurrent Ways and Means markup of crucial telehealth legislation, specifically H.R. 8261, the Preserving Telehealth, Hospital, and Ambulance Access Act.

The second half of the event featured:

• Omolola Taiwo, PhD, MPA, executive director, Office of Primary Care and Rural Health, New Jersey Department of Health
• Sarah Peterson, attorney and employment-based immigration expert, Fragomen
• David B. Watson, MD, professor and chair, Department of Neurology, West Virginia University (WVU)
• Umer Najib, MD, associate professor, vice chair for clinical operations, director, WVU Headache Center

The speakers outlined the key tenets and benefits of this policy for international medical graduates (IMGs) and answered audience questions.

The AMA was pleased to join AAN and PAHA as a host of this important event that has already produced five additional House cosponsors of H.R. 4942. AMA will continue to press members of the House and Senate to enact this bill that helps IMGs who come to the United States on a J-1 visa remain in this county upon completion of their residency program in exchange for working in an underserved community for three years.

Buprenorphine for the treatment of opioid use disorder (OUD) should be removed from manufacturers’ and distributors’ suspicious order report algorithms to avoid the risk of harmful delays and denials of care, the AMA, American Society of Addiction Medicine, American Pharmacists Association and American Society of Health-System Pharmacists wrote (PDF) last week to the U.S. Drug Enforcement Administration, Assistant Secretary for Health, Office of National Drug Control Policy, and Substance Abuse and Mental Health Services Administration.

A recent meeting of the AMA Substance Use and Pain Care Task Force confirmed reports from individual physicians that problems for patients accessing buprenorphine from their pharmacies have escalated in recent months. The organizations said that they:

“Are deeply concerned about reports from our members that patients with an OUD have struggled to have prescriptions for buprenorphine products dispensed at pharmacies. It is beyond comprehension that at a time when we all have worked so hard to remove barriers to MOUD that this threshold barrier would rear up and put patients’ lives in jeopardy.

Two prevailing themes are clear:

• Pharmacies have not increased orders for MOUD because of fears by distributors and pharmacies of exceeding thresholds, which would trigger suspicious order reports (SOR) and subject the pharmacy and distributor to increased DEA scrutiny.
• As a result of the scrutiny and subsequent challenges with pharmacies obtaining sufficient stock of buprenorphine products, patients continue to face delays and denials of MOUD—frustrating the nation’s pharmacists and physicians and exacerbating the nation’s overdose and death toll.”

Recent federal guidance from these agencies (see more) urging manufacturers and distributors to increase access to buprenorphine for OUD is important, but the organizations emphasized that they have “received multiple reports from physicians and pharmacy colleagues that distributors are delaying or suspending orders of MOUD because of the national opioid settlement agreement.” The settlement specifically lists buprenorphine as a drug of concern, subjecting it to higher levels of scrutiny and restriction.

“As long as buprenorphine products approved by the FDA for OUD remain prevalent in SOR reporting requirements and the opioid litigation settlement agreements, access to these buprenorphine products will remain a struggle across the country,” the organizations wrote. “This is why we urge clear guidance that explicitly states that suspicious order reporting requirements will not be enforced against buprenorphine approved by the FDA for OUD until further notice.”

The AMA urges state medical associations to share the recent letter (PDF) with appropriate state officials to highlight this issue.

The AMA—alongside the Alliance of Community Health Plans, American Academy of Family Physicians, Association for Community Affiliated Plans, and Blue Cross Blue Shield Association—sent a letter (PDF) to the secretary of the U.S. Department of Health and Human Services (HHS) encouraging federal officials to evaluate HIPAA’s breach notification obligations within the context of the Change Healthcare cybersecurity incident.

UnitedHealthcare has revealed that protected health information (PHI) and personally identifiable information (PII) for a “substantial proportion of people in America” was compromised as a result of the cyberattack. Under HIPAA’s rules, all Covered Entities—including providers, payers, and clearinghouses—would be obligated to notify individuals regarding this situation.

According to the letter, this obligation would mean, for example, that “a patient with diabetes could be notified by their primary care physician and endocrinologist; an EHR company; their local hospital; their local pharmacy; a specialty pharmacy; their employer; and their health plan’s administrator—with many other possible notifications as well. All regarding the one data breach at Change.” This could lead to understandable confusion as impacted individuals are overwhelmed by multiple notifications.

To avoid this confusion, the organizations requested that—in alignment with the United CEO’s statement that “we are offering to take full responsibility for all notification obligations for everyone involved in this”—the Office of Civil Rights issue clear guidance that only Change Healthcare has an obligation to issue breach notifications in this context.

A new Policy Research Perspective (PDF) uses AMA’s nationally representative Physician Practice Benchmark Survey to provide a detailed look at how physicians were compensated by their practices from 2012 to 2022. The percentage of physicians paid by a combination of two or more methods increased from 48.2% in 2012 to 61.0% in 2022 due to an increase in the percentage of physicians who received more than half their compensation from salary combined with at least one other method, namely bonus. The report also examines differences across physician employment status, physician specialty and practice ownership.

• May 17, 2024: Advocacy Update spotlight on the need for improved maternal health care
• May 17, 2024: Medicare Payment Reform Advocacy Update
• May 17, 2024: State Advocacy Update